Provider Demographics
NPI:1609137942
Name:AUDIOLOGY SPECIALTY CLINIC
Entity type:Organization
Organization Name:AUDIOLOGY SPECIALTY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:605-275-5545
Mailing Address - Street 1:5124 S WESTERN AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5047
Mailing Address - Country:US
Mailing Address - Phone:605-275-5545
Mailing Address - Fax:605-275-5546
Practice Address - Street 1:5124 S WESTERN AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5047
Practice Address - Country:US
Practice Address - Phone:605-275-5545
Practice Address - Fax:605-275-5546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD375231H00000X
SD11231H00000X
SD16231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD375OtherAUDIOLOGY LICENSE
SD1487964144OtherNPI
SD1184899882OtherNPI
SD1538334131OtherNPI
SD16OtherAUDIOLOGY LICENSE
SD11OtherAUDIOLOGY LICENSE